Pathological Fracture

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Pathological Fracture
Define pathological fracture:
Pathological fracture is a term used to refer to loss of continuity
in the substance of a bone (= "fracture")
when the bone itself is either abnormal or diseased
(pathological fracture).
The terms "pathological fracture" and "pathologic fracture" are both
used with the same meaning.
A simpler definition of a pathological (or pathologic) fracture" is:
"A pathologic(al) fracture is a broken bone
resulting from disease leading to weakness of
the bone."
The above simple answer to the question "what is a pathological
fracture?" may be easier for non-specialists to remember but is
less accurate, the term "broken bone" being a simplification of the
various different types of fractures, including e.g. incomplete
fractures such as hairline fractures.
The expression "broken bone" is generally understood and widely
used by non-medical personnel but is not a formal orthopedic term.
The stricter definition at the top of the page is therefore more
accurate.
In summary:
The word fracture refers to damage "loss of continuity" to bone(s). When used on its own the word pathology generally refers
to diseases or disease processes. Pathological fractures are damaged bones that are also affected by an abnormality or
disease, of which there are several possibilities - listed in the following table.

Pathological processes that can lead to a pathological fracture

or whose presence causes fractures of affected bones to be classified as "pathological fractures":
This list of pathological fractures - overview is in alphabetical order. Numbers on the left are just to show how many pathological processes are included.

Cause (pathology)

Description of pathological process

1.

Osteitis

Osteitis is a general term used to refer to inflammation of bone.

It is also part of certain terms/names used to refer to some specific conditions e.g. Von
Recklinghausen's disease of bone (also known as osteitis fibrosa cystica).

2.

Osteogenesis imperfecta

Osteogenesis imperfecta is a hereditary disorder that is usually diagnosed in infancy or

childhood (but sometimes not until later in life) in which fragile bones lead to symptoms
including:
Bowing of long bones, e.g. in the legs
Bone deformities
Stunted growth
Pathological fractures.

3.

Osteomalacia / Rickets

Osteomalacia is a condition affecting bones and muscle in adults. In children who are still
growing the same condition is known as rickets. Symptoms include bones becoming soft
and prone to pain and fractures due to insufficient or defective bone mineralisation, i.e. the
bones are not sufficiently hardened by minerals containing calcium and phosphate. Causes
include:
Severe and prolonged deficiency of vitamin D - which regulates the bone-building
process and the body's use of calcium and phosphate to form strong, hard bones.
Insufficient sunlight on the skin - which leads to deficiency of vitamin D because
vitamin D is made in the body by the action of sunlight on the skin. Lack of sunlight
on the skin is the main reason that people get vitamin D deficiency and
osteomalacia.
Some medical conditions and some medicines increase risk of vitamin D deficiency
and consequent osteomalacia.
Some rare inherited conditions affect bone mineralisation and cause osteomalacia.
Aluminium poisoning (also rare).

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4.

Osteoporosis

Osteoporosis is the most common cause of pathological fracture.

It generally involves failure of bone tissue formation or maintenance - resulting in bones
having a translucent appearance on X-Ray images.

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Reduced hormone levels - associated with age, esp. menopause.

Lack of use of affected bone(s) e.g. due to injury
Complication or after-effect of rheumatoid arthritis
Deficiency of vitamin C

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5.

Paget's disease

Paget's disease is a chronic bone disorder involving breakdown and formation of bone
tissue that can result in weakened bones, pain, mis-shapen bones, bone fractures, and
arthritis in the joints near the affected bones. It usually affects local areas only, e.g. just
one or a few bones, as opposed to all the bones in the body. Severity varies from person
to person. Conventional medication is available.

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It has been claimed (no reference found) that chalkstick fractures are common in cases of
Paget's disease.
6.

Primary malignant bone

tumours

There are several types of primary malignant bone tumours, e.g.

7.

Secondary malignant
bone tumours

The most common malignant bone tumour is the metastatic deposit, that is a tumour that
has metastasized (moved, or spread) from another part of the body, e.g. from an adjacent
organ within the body. Secondary tumours found in bone tissue may, for example, occur
from primary growths in the lung, breast or kidney.

8.

Simple bone tumours and

cysts
e.g. enchondromata and
unicameral bone cysts

malignant change in an osteoclastoma

osteogenic sarcoma
chondrosarcoma
fibrosarcoma
Ewing's tumour

Benign (non-cancerous) cartilaginous tumours called enchondromata are

sometimes the cause of pathological fractures. They occur most commonly in the
bones of the hands or feet, i.e. the metacarpals, metatarsals and phalanges.
Unicameral (simple) bone cysts are benign cavities within a bone that are filled
with straw-colored fluid. They occur in one location in one bone, usually in people
under 20 years old. In children aged 5 - 15 years, a unicameral bone cyst is one of
the most common causes of pathological fracture e.g. in the upper arm or upper-leg.
There is no known cause. Little is known about the development of unicameral bone
cysts.

How do these pathological processes lead to pathological fractures ?

The mechanisms by which the bone conditions and diseases listed above can lead to a pathological fracture or
fractures vary. In some cases the pathological process causes sufficient weakening of the structure and tissues of
the bone that fracture(s) may occur either spontaneously or as a result of only slight injury e.g. an impact sustained
in the course of normal day-to-day activities.

How is a pathological fracture identified or diagnosed ?

When the bone condition (pathology) is already known to the person and his/her medical practitioners, the
pathological nature of the fracture may be expected and confirmed by medical imaging.
When the existence of a bone condition (pathology) is not known to the patient or medical practitioner, a bone
fracture resulting from a seemingly trivial event or injury may be an initial cause for concern. In any case the
medical images, e.g. X-rays, may provide the first clear evidence of a pre-existing bone pathology and may lead to
further tests and/or treatment.
This is the end of this page about pathological fractures. See also types of fractures, types of joints and skeletal disorders.

... End of Page ...

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Today's Study Tip: Reviewing information at frequent intervals e.g. monthly is helpful for effective learning. - 17th
September 2013.

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